Health System Factors Affecting The Provision of Post-Abortion Care by Primary Healthcare Facilities in Trans-Nzoia County, Kenya

Abstract

Background: Globally, millions of women experience complications following abortion, requiring post-abortion care (PAC) (Magnus, 2019). The situation is worsened by inadequate PAC services. In Kenya, the provision of quality PAC services is supported by several policy documents, including The Constitution of Kenya (2010), the Kenya Health Policy, the Primary Healthcare Strategy, the Health Product and Technologies Supply Chain Strategy, and the Ministry of Health's 2019 PAC Guidelines. Objectives: The study aimed to investigate health system factors affecting the provision of PAC by Primary Health Care (PHC) facilities in Trans-Nzoia County, Kenya. Specifically, it sought to identify service delivery factors, human resource factors, and essential supply-related challenges influencing PAC service provision. Methods: A cross-sectional mixed methods study design was used. Data collection tools included structured questionnaires and key informant interviews. Quantitative data were analyzed using SPSS version 23, while qualitative data were transcribed and analyzed using NVIVO. Results: Out of 160 sampled PHC facilities, the response rate was 81.25%. Key findings showed significant associations (p<0.05) between PAC provision and cost of services, patient waiting time, treatment protocols, facility operating hours, and availability of trained staff and supplies. Only 50 providers were fully trained in PAC, while 71 had partial, on-the-job training. Awareness of the 2019 MOH PAC Guidelines was low at 40% among facility managers. Gaps also existed in distribution of functional Manual Vacuum Aspiration (MVA) kits and PAC-specific budgets. Conclusion: All null hypotheses were rejected. Health system service delivery, human resource capacity, and essential supplies significantly influence PAC provision in Trans-Nzoia County. The study recommends targeted interventions to address these gaps, including further research disaggregated by PHC level and outcome-based client evaluations to enhance PAC service delivery.